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REVIEW ARTICLE
Reflexology in Childbirth Pain Management
Hadis Rahimi1, Hossein Elyasi1, Nasrin Galehdar2
1
Department of Medical Sciences, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
2
Department of Surgical Technology, School of Paramedicine, Lorestan University of Medical Sciences, Khorramabad, Iran
Received: 12 Oct. 2020; Accepted: 28 May 2021
Abstract- This study was conducted to review the related articles and draw a final conclusion regarding the
application of reflexology for delivery (labor and cesarean section) pain management in women all over the
world. In this systematic review, relevant articles were searched in Google Scholar, PubMed, Cochrane
Library, Science Direct, and Scopus databases from the year 2000 to 2018. All the human clinical trials that
examined the effects of reflexology methods on delivery pain (labor or Cesarean section) were included, and
others were excluded from the study. All the 18 included original articles (with 1391 patients) reported that
reflexology significantly reduces the pain of delivery, confirming its decreasing effect on labor, Cesarean
section, and post-delivery pain. Results of all articles showed that if true reflexology is performed on the right
location of the body and at the appropriate time, the pain of delivery can be significantly decreased.
Reflexology is appropriate pain relief and prophylaxis for any kind of pain, especially delivery and post-
delivery pain. It is a safe remedy with no adverse effects reported so far.
© 2021 Tehran University of Medical Sciences. All rights reserved.
Acta Med Iran 2021;59(6):312-321.
Keywords: Childbirth pain; Complementary medicine; Reflexology
Introduction that reflexology may have profits in the palliative care of
people with cancer (18-24). Reflexologists claim that
The application of pressure to areas on feet, hands, reflexology is also able to treat a wide range of medical
ears, and other parts of the body is called reflexology (1- conditions such as asthma, diabetes, and cancer.
3). Reflexology may be an effective method to alleviate However, scientific evidence is required to verify these
stress and is commonly relaxing. The theory behind claims (25-27).
reflexology states that these areas correspond to organs Reflexology is generally believed to be safe, even
and systems of the body (4,5). Its proponents believe though very vigorous pressure may cause discomfort for
that pressure applied to these areas affects the organs some people. Besides, it is an alternative treatment for a
and has health benefits. Foot charts guide reflexologists variety of conditions and has been used for thousands of
when they apply pressure to specific areas (6-8). Rubber years. In ancient times, the Chinese and Egyptians had
balls, rubber bands, and sticks of wood are the items documented practices very similar to reflexology as
these practitioners sometimes utilize for assistance. treatments for certain afflictions. This method involves
Practitioners of reflexology are, among others, the reflexologist exerting pressure on specific regions in
chiropractors, physical therapists, and massage the hands, feet, and ears that affect certain reflex areas
therapists (9-12). of the body (28-31). The theory behind reflexology is to
Several studies conducted by the National Cancer align your qi, but even for those who normally do not
Institute and the National Institutes of Health show that have much trust in reflexology, there are numerous
reflexology may lessen pain and psychological studies backing up the claims of reflexologists. This
symptoms, such as nervousness and depression, and method is not broadly accepted in the medical world, but
improve relaxation and sleep (13-17). Studies also report a large number of physicians worldwide have been
Corresponding Author: N. Galehdar
Department of Surgical Technology, School of Paramedicine, Lorestan University of Medical Sciences, Khorramabad, Iran
Tel: +98 9163611417, Fax: +98 2142910703, E-mail address: Galehdar_n@yahoo.com
Copyright © 2021 Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International license (https://creativecommons.org/licenses/by-
nc/4.0/). Non-commercial uses of the work are permitted, provided the original work is properly citedH. Rahimi, et al.
employing reflexology for generations with and the stretching of the birth canal and vagina. Every
astonishingly positive results (32-36). woman has a different feeling of pain during labor
The benefits of reflexology include its capability to (79,80). Although labor is often thought of as one of the
stimulate nerve function, increase energy, boost most painful events experienced by humans, it varies
circulation, and induce a deep state of relaxation (37- highly from woman to woman and even from pregnancy
44). Furthermore, it helps stimulate the central nervous to pregnancy. Women experience labor pain differently.
system and avoid migraines (45-50). This sort of For some, it feels like menstrual cramps; for others,
massage speeds up recovery after an injury or surgery, severe pressure; and for others, extremely strong waves
decreases sleep disorders, and relieves depression and that feel like diarrheal cramps (81-86).
pain. It also helps facilitate the treatment of different Many pregnant women all over the world search for
types of cancer and alleviate pregnancy-related pains, a method to reduce the pain of delivery, and many of
even those occurring after delivery (51-63). these methods have their own risks and problems.
Whether you work in an office, plant, field, hospital, Reflexology is a safe and proven way to decrease
or any other place, there is a good chance that you put various types of pain. Therefore, the present study was
heavy weights and stress on your feet every day. It is not conducted to review the related articles and draw a final
always the back; stress can manifest itself in the other conclusion regarding the application of reflexology for
parts of our body too. This special area of massage delivery pain management.
therapy also includes hands and ears, making it a holistic
massage (64,65). Materials and Methods
When an egg is fertilized by a sperm, the result is
pregnancy. Then, an embryo grows inside a woman's Relevant articles were searched in Google Scholar,
uterus and develops into a baby (66,67). In humans, this PubMed, Cochrane Library, Science Direct, and Scopus
process lasts about 264 days from the date of databases by searching English article topics same to our
fertilization. Labor happens in three phases. The first topic and equal and same to our article keywords
phase begins with contractions and continues until the (Reflexology, acupressure, massaging in combination
cervix has become thinner and dilated to about 4 inches with labor, labor pain, cesarean, cesarean pain, delivery,
wide (68,69). The second phase is the active one, in delivery pain, post-delivery pain management, childbirth
which the mother starts to push the embryo downward. pain, and pain management) from 2000 to 2018. All the
Crowning is when the baby's scalp can be seen and, a articles were searched by two members of our research
short time after, the baby is born (70,71). In the third group in a double-blind manner for better quality and
phase, the placenta exits the uterus. During pregnancy, accuracy of the work. All the studies that examined the
the placenta supplies food and oxygen to the baby effect of reflexology methods on delivery pain (labor
(72,73). Both mother and baby are monitored thoroughly and Cesarean section) were included, and others were
during labor. The majority of women can have a baby excluded from this study.
through normal vaginal delivery. When there are In the first search, 463 articles were found. After
complications, the baby may need to be delivered removing duplications, 294 articles remained, and after
surgically by a Cesarean section (74,75). removing articles belonging to years before 2000 as well
Pain during labor is created by pressure on the cervix as those related to any kind of massage therapy except
caused by contractions of the muscles of the uterus. This for reflexology, 114 articles remained. Finally, after the
pain can be felt as strong cramping in the abdomen, examination of articles’ abstracts, 18 articles met the
back, and groin, as well as an achy feeling (76-78). inclusion criteria and were included. The search process
Some women also experience pain in their sides or is showed in Figure 1.
thighs. Other reasons for pain during labor include
pressure on the bladder and bowels by the baby's head
Acta Medica Iranica, Vol. 59, No. 6 (2021) 313Reflexology in childbirth pain management
Figure 1. The searching strategy in preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram
Results 2000 and any other study that worked on massage and
unspecialized massaging were excluded. We extracted
Five internet databases were selected for searching data about the first author, year of publication, delivery
about records of reflexology (Google Scholar, PubMed, type, and all of the important results of the included
Cochrane Library, Science Direct, and Scopus) in records and showed them in Table 1.
addition to various books. Any study before the year
Table 1. Studies on the effect of reflexology and their outcomes
Delivery Number of
Row First author Year Results
type participants
The severity of pain in the first day was significantly decreased in comparison
to the time before reflexology and the control group (pH. Rahimi, et al.
Cont. table 1
Mean PSQI was found to be meaningfully smaller in the reflexology group
(pReflexology in childbirth pain management
role for labor, Cesarean section, and post-delivery pain. hormone also reduces the level of catecholamine that
Based on the several foot reflexology chart and increases blood pressure and cardiac output (113-118).
included articles in this study, several zones on the sole Changes in the sensitivity of barometric receptors in
of the foot, especially three forth of the low part of foot different situations can increase or decrease blood
bottom and its internal margins, are the main pressure. Also, these baroreceptors have an inhibitory
determining parts to deal with the pain of about effect on the brain under the influence of reflexology,
abdomen to pelvic regions and so related to delivery thereby decreasing muscle tension and stimulating sleep
pain. Exerting massage on these specific points or just and the inhibition of the sensory nerves of the spinal
massaging the whole foot sole was effective and cord that decreases pain and anxiety (119-123).
significant in all studies. Dysfunction in each part of the body and even the
Here, 18 clinical trials and 1391 patients with normal functioning of the body leads to the formation of
delivery pain were surveyed. Results of all articles uric acid and calcium crystals, usually occurring in the
showed that if true reflexology is performed on the right feet and their nerves. This sediment prevents the flow of
location of the body and at the appropriate time, the pain lymph and even blood. Reflexology causes this material
of delivery can be significantly decreased. to be discarded, resulting in the flow of lymph and blood
Approximately 293 patients from all included in the area (124-128). In reflexology, pressure on the
articles were among the Cesarean section group, and the foot causes cell receptors to open the ion channels in the
other was in the labor group, and 363 patients of all plasma, thereby causing a local action potential and
were among the post-delivery pain group. All three transmitting these messages to the spine and the brain
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